US5814301A - Use of prostacyclin derivatives to prevent or to treat disorders of the microcirculatory system when x-ray, NMR or ultrasonic contrast media are administered - Google Patents

Use of prostacyclin derivatives to prevent or to treat disorders of the microcirculatory system when x-ray, NMR or ultrasonic contrast media are administered Download PDF

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US5814301A
US5814301A US08/232,006 US23200695A US5814301A US 5814301 A US5814301 A US 5814301A US 23200695 A US23200695 A US 23200695A US 5814301 A US5814301 A US 5814301A
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group
administration
iloprost
hydroxy
formula
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Rainer Klopp
Wolfgang Niemer
Wolfgang Schippel
Werner Krause
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Bayer Pharma AG
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Schering AG
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    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B82—NANOTECHNOLOGY
    • B82Y—SPECIFIC USES OR APPLICATIONS OF NANOSTRUCTURES; MEASUREMENT OR ANALYSIS OF NANOSTRUCTURES; MANUFACTURE OR TREATMENT OF NANOSTRUCTURES
    • B82Y5/00—Nanobiotechnology or nanomedicine, e.g. protein engineering or drug delivery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
    • A61K47/69—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the conjugate being characterised by physical or galenical forms, e.g. emulsion, particle, inclusion complex, stent or kit
    • A61K47/6949—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the conjugate being characterised by physical or galenical forms, e.g. emulsion, particle, inclusion complex, stent or kit inclusion complexes, e.g. clathrates, cavitates or fullerenes
    • A61K47/6951—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the conjugate being characterised by physical or galenical forms, e.g. emulsion, particle, inclusion complex, stent or kit inclusion complexes, e.g. clathrates, cavitates or fullerenes using cyclodextrin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K49/00—Preparations for testing in vivo
    • A61K49/0002—General or multifunctional contrast agents, e.g. chelated agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/10—Dispersions; Emulsions
    • A61K9/127—Liposomes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system

Definitions

  • Contrast media are essential auxiliary agents in medical diagnosis. They make possible increasingly greater contrast in the pictures obtained as well as better detection of the various tissues and organs. Among other things, they are used in x-ray, ultrasonic and magnetic resonance processes. There are a multitude of undesirable side effects with respect to this very useful application, such as, for example, changes of endothelial cells, damage of the erythrocytes, influencing of the blood clotting system, disorder of the microcirculatory system up to complete hemostasis, increase of the already existing disorder of the microcirculatory system in the pathogenic tissue, changes of the blood-brain barrier or negative influencing of the blood pressure. The disorder of the microcirculatory system is especially important.
  • the microcirculatory system is functionally the most important part of the circulatory system.
  • the metabolism takes place in the area of the microcirculatory system.
  • a disorder of the microcirculatory system among others, reduction of the blood cell-perfused branch points, increase of adhesions of the blood cells on the inner wall of the venules and erythrocyte aggregation can be observed.
  • the arteriolar vasomotion is also impaired.
  • a number of diseases, not only of the cardiovascular system are attributable to disorders of the microcirculatory system. Therefore, it is absolutely desirable to avoid or to treat immediately a disorder of the microcirculatory system as a consequence of administering a contrast medium.
  • the prostacyclin derivatives of this invention maintain or restore the microcirculatory system to a significant extent when administered shortly before or after administering x-ray, ultrasonic or NMR contrast media or when jointly administered with said contrast media.
  • the invention relates to the use of a prostacyclin derivative or of the corresponding ⁇ -cyclodextrin clathrate or of the form encapsulated with liposomes for the production of a pharmaceutical agent to prevent or to treat disorders of the microcirculatory system when x-ray, NMR or ultrasonic contrast media are administered.
  • This invention preferably relates to the use of one or more prostacyclin derivatives of general formula I ##STR2## in which R 1 means hydrogen or a C 1 -C 4 alkyl radical,
  • n 0 to 3
  • X, Y independently of one another, mean a --CH 2 group or an oxygen atom
  • Z means hydrogen, fluorine or CN
  • A means a trans --CH ⁇ CH-- or a --C ⁇ C group
  • W means a hydroxymethylene group that is free or functionally modified on the hydroxy group, in which the hydroxy group can be in ⁇ - or ⁇ -position,
  • D means a straight-chain or branched, saturated C 1 -C 5 alkylene group
  • E means a --C ⁇ C group
  • R 2 means a C 1 C 2 alkyl group
  • R 3 means a free or functionally modified hydroxy group, and if R 1 means hydrogen, its salts with physiologically compatible bases, as well as its ⁇ -, ⁇ - or ⁇ -cyclodextrin clathrates as well as its form encapsulated with liposomes or ataprost, beraprost, BW-15AU, ciprostene, CS 570, FCE 22509, naxaprostene, RS-93427, SC 39902 or taprostene for the production of a pharmaceutical agent to prevent or to treat disorders of the microcirculatory system when x-ray, ultrasonic or NMR contrast media are administered.
  • This invention especially preferably relates to the use of the prostacyclin derivatives iloprost, iloprost-clathrate, cicaprost, cicaprost-clathrate, eptaloprost or eptaloprost-clathrate.
  • alkyl groups in R 1 straight- or branched-chain alkyl groups with 1-4 C atoms are to be considered, such as, for example, methyl, ethyl, propyl, isopropyl, butyl, isobutyl, tert-butyl.
  • Alkyl groups R 1 can optionally be substituted by halogen atoms, methoxy, ethoxy, phenyl or (C 1 -C 2 )-dialkylamines.
  • substituents there can be mentioned, for example, fluorine, chlorine or bromine atoms, phenyl, dimethylamine, diethylamine, methoxy or ethoxy.
  • Preferred alkyl groups R 1 are methyl, ethyl, dimethylaminopropyl.
  • alkyl group R 2 methyl and ethyl can be mentioned.
  • the hydroxy groups in R 3 and W can be present as free hydroxy groups, in which the hydroxy group in W is preferably in ⁇ -position or can be functionally modified, for example, by etherification or esterification. Free hydroxy groups are preferred.
  • ether or acyl radicals the radicals known to one skilled in the art are considered.
  • Preferred are easily cleavable ether radicals, such as, for example, tetrahydropyranyl, tetrahydrofuranyl, ⁇ -ethoxyethyl, trimethylsilyl, dimethyl-tert-butylsilyl, diphenyl-tert-butylsilyl or tribenzylsilyl.
  • acyl radicals there can be mentioned, for example, acetyl, propionyl, butyryl or benzoyl.
  • alkylene group D straight-chain or branched, saturated alkyl groups with 1-5 C atoms are considered, for example, methylene, ethylene, 1- or 2-propylene, ethylethylene, trimethylene, tetramethylene, pentamethylene, 1-methyldimethylene, 1-methyltrimethylene, 1-methyltetramethylene.
  • alkali hydroxides such as sodium or potassium hydroxide
  • alkaline-earth hydroxides such as calcium hydroxide
  • ammonia amines
  • amines such as ethanolamine, diethanolamine, triethanolamine, N-methylglucamine, morpholine, tris(hydroxymethyl)methylamine, etc.
  • the clathrates with ⁇ -, ⁇ - or ⁇ -cyclodextrin are obtained analogously to the instructions of WO 87/05294.
  • Preferred clathrates are those with ⁇ -cyclodextrin.
  • Liposomes are produced, e.g., according to the process described in "Pharmazie in ken Zeit Pharmaceutics in Our Time! 11, 98 (1982)."
  • EP 86404 B1 the use of carbacyclins to prevent and treat ischemic attacks of the central nervous system, for cytoprotection in the liver and in the pancreas as well as the combination with ⁇ -blockers or diuretics is described.
  • WO 86/00808 the cytoprotection of the kidneys as well as the suitability of the prostacyclin derivatives of formula I to treat organs to be transplanted is known.
  • DE 35 26 362 A1 the combination of the prostacyclin derivatives of formula I with thromboxane antagonists for use in the case of thrombotic or thromboembolic syndromes is described.
  • the disorders of microcirculatory system observed with the use of a contrast medium in an animal test such as, e.g., drastic reduction of the blood cell-perfused branch points in the microvascular network, increase of aggregated erythrocytes, increased adhesions of white blood cells to the inner wall of the venules as well as impairment of the arteriolar vasomotion, are especially pronounced in the second and seventh minutes after the contrast medium is administered, which coincides with the clinical empirical findings on side effects of and incidents with contrast media (so-called immediate reaction after about 2 minutes or so-called delayed reaction after about 7 minutes).
  • the administration of the claimed compounds before, simultaneously with and after administration of contrast media produces a substantial avoidance or a decidedly reduced disorder of the microcirculatory system connected with a faster restoration of the microperfusion.
  • the claimed compounds can be administered topically or intravascularly (i.a., i.v.).
  • the contrast medium is administered intravascularly (i.a., i.v.).
  • the dose of the prostacyclin derivatives is 1.6-0.0004 ⁇ g/kg of body weight, preferably 1.2 -0.0004 ⁇ g/kg of body weight.
  • this invention further relates to the combination of prostacyclin derivatives with contrast media, in which prostacyclin derivatives and contrast media can be present in one or in separate dosage units.
  • X-ray, ultrasonic and NMR contrast media are suitable for the combination.
  • Preferred contrast media for the combination are iotrolan, iopromide, iohexene, iosimide, metrizamide, salts of amidoacetic acid, iotroxic acid, iopamidol, 5-hydroxyacetamido-2,4,6-triiodo-isophthalic acid-(2,3-dihydroxy-N-methylpropyl)(2hydroxyethyl)-diamide, 3-carbamoyl-5- N-(2-hydroxyethyl)-acetamido!-2,4,6-triiodo-benzoic acid (1RS,2SR)-2,3-dihydroxy-1-hydroxymethylpropyl!amide, dispersions of iodipamide ethyl ester, gadolinium DTPA, gadolinium DOTA, the gadolinium complex of 10 1-hydroxymethyl-2,3-dihydroxypropyl!-1,4,7-tris (carboxymethyl)-1,4,7,10
  • the dosage unit of the contrast media can be 1-350 mg of iodine/1 for x-ray contrast media, 1-1000 ⁇ g of particles/kg of body weight for ultrasonic contrast media and 0.01-0.5 mol for NMR contrast media. But these data can be only guide values, since the contrast medium dosage depends greatly on the desired use.
  • Prostacyclin derivatives especially those mentioned under claim 2, are suitable for the combination.
  • the dose of prostacyclin derivatives for the combination lies in the range already indicated for the separate administration.
  • FIG. 1 A first figure.
  • a microcatheter for intraarterial injection of the contrast medium is moved from the A. carotid communis up to the aortic arch in anesthetized rats of the Wistar-Schdowalde strain (anesthesia with urethane-chloralose mixture--i.p., i.m.--10% urethane in isotonic NaCl solution, 2% ⁇ -chloralose in isotonic NaCl solution; 0.6 ml/100 g of body weight as initial dose, 0.2 ml/100 g of body weight as maintenance dose if necessary).
  • One-time injection of a body-temperature bolus of amidotrizoate/urografin with 600 mg of iodine/kg of body weight takes place.
  • the injection time is 30 seconds.
  • the administration of iloprost takes place 5 minutes after administration of contrast medium, with intraarterial administration by the same injection path as the contrast medium, with intravenous administration via V. femoralis and with topical administration via intestine/mesentery.
  • the iloprost dose is 0.8-1.6 ⁇ g of iloprost/kg of body weight in 2.0 ml of solution/kg of body weight. With topical administration, 3 drops of this solution are used.
  • the number of test animals is 45 with intraarterial administration, 25 with intravenous administration and 20 with topical administration.
  • the control animals receive physiological common salt solution in the corresponding administration.
  • the number of control animals is 12 with intraarterial and intravenous administration and 20 with topical administration.
  • the blood cell-perfused branch points of the intestinal microflow increase by administration of iloprost.
  • the comparison with the untreated control shows that iloprost clearly damps the disorders of the microcirculatory system induced by contrast medium in the clinically significant time interval of the 5th to 10th minutes p.a. of amidotrizoate and that a faster restoration of the physiological microperfusion is achieved.
  • FIG. 1 shows the percentage reduction of the blood cell-perfused branch points in the microvascular network of the mesentery with administration of contrast medium in comparison to the initial conditions as well as the effect of the iloprost administration.
  • the trabecular presentation indicates average values x, the superposed lines standard deviation S.
  • the percentage portion of aggregated erythrocytes of the total cell number in the mesenteral network is greatly reduced by iloprost, i.e., the reduction of the number of aggregated erythrocytes is accelerated.
  • FIG. 2 shows the percentage increase of the portion of aggregated erythrocytes of the total cell number in the microvascular network of the mesentery with administration of contrast medium in comparison to the initial conditions as well as the effect of the iloprost administration.
  • Animal groups 1 and 2 were treated as in the above test. The presentation of the average values or standard deviation takes place as in FIG. 1.
  • FIG. 3 shows the number of adhering blood cells on a defined inner wall surface of the venules of the mesentery as a function of time.
  • Animal groups 1 and 2 were treated as in the above test. The presentation of the average values or standard deviation takes place as in FIG. 1.
  • One-time injection of a body-temperature bolus of diatrizoate/urografin with 600 mg of iodine/kg of body weight takes place.
  • the injection time is 30 seconds.
  • the administration of iloprost takes place 5 minutes after administration of contrast medium, with intravascular administration in the same injection path as the contrast medium or with topical administration via intestine/mesentery.
  • the iloprost dose is 1.6-0.0004 ⁇ g of iloprost/kg of body weight in 2.0 ml of solution/kg of body weight. With topical administration, 3 drops of this solution are used.
  • physiological common salt solution with a suitable volume is administered. Because of the small differences of the body weights of the test animals, an almost identical bolus volume of about 1 ml can be administered in all test animals. The number of test animals is 10 per treatment group.
  • Number of the currently cell-perfused branch points in the microvascular network (%, percentage change of the number in comparison to the initial conditions);
  • % percentage portion of aggregated erythrocytes of the total cell number in the observed stream bed; as erythrocyte aggregation, a prolonged adhering of at least 2 to 3 erythrocytes is observed, in which the different types of aggregation are not differentiated);
  • BZ/A number of adhering blood cells on the inner wall of the venules
  • arteriolar vasomotion determination of the inner diameter of an arteriole with a diameter of about 45 ⁇ m on a specific site at each second in the observation interval of about 15 minutes; determination of the amplitude-frequency spectrum of the vasomotion oscillation).
  • the measurable variables are determined in microvessels with diameters ⁇ 40 ⁇ m.
  • the measurements of the microcirculatory features are made on the mesentery of the small intestine and on the mucous membrane of the small intestine itself in complete, in each case identical segments.
  • the intestine is surgically exposed on the anesthetized and thermostated animal and evacuated in a bath solution thermostated at body temperature (equivalent to the intraperitoneal liquid).
  • the presentation of the microvascular network takes place with the help of an intravital microscopic examination unit in the combined incident light-transmitted light process on the intact organ with computer-assisted image manipulation and processing.
  • the vital microscopic assessments are made with constant macrocirculatory boundary conditions.
  • an orienting survey of the complete microvascular network of the entire mesenteric or intestinal segment is obtained--including its other inflows and outflows, branching geometry and hierarchy and functional vessel identification.
  • the anatomical vessel identification in the stained histological preparation takes place after the end of the test within the scope of the final histopathological study of all test animals.
  • the recording of data takes place usually at an interval of 5 minutes before the administration of contrast medium to 10 minutes after the administration of contrast medium every minute.
  • the number of blood cell-perfused branch points increases more quickly by administration of iloprost.
  • the portion of aggregated erythrocytes of the total blood cell number in the network decreases more quickly after administration of iloprost.
  • the number of blood cells adhering to the inner wall of the venules decreases by iloprost.
  • the frequency spectrum of the arteriolar vasomotion exhibits smaller deviations from the normal state by iloprost administration than in exclusive administration of contrast media (see FIG. 4-6).
  • FIG. 4 shows the frequency spectrum of a control animal
  • FIG. 5 shows the frequency spectrum of an animal in the seventh minute after intravenous administration of diatrizoate
  • FIG. 6 shows the frequency spectrum of an animal, which was administered iloprost with a dose of 0.8 ⁇ g/kg 5 minutes after intravenous administration of diatrizoate in the same path of injection, in the seventh minute after administration of contrast medium, i.e., in the second minute after iloprost injection.
  • One-time injection of a body-temperature bolus of diatrizoate/urografin with 600 mg of iodine/kg of body weight takes place.
  • the injection time is 30 seconds.
  • the administration of iloprost takes place simultaneously with the administration of contrast medium, with intravascular administration in the same injection path as the contrast medium or with topical administration via intestine/mesentery.
  • the iloprost dose is 1.6-0.0004 ⁇ g of iloprost/kg of body weight in 2.0 ml of solution/kg of body weight.
  • topical administration 3 drops of this solution are used.
  • physiological common salt solution with a suitable volume is administered. Because of the small differences of the body weights of the test animals, an almost identical bolus volume of about 1 ml can be administered in all test animals. The number of test animals is 10 per treatment group.
  • Number of the currently cell-perfused branch points in the microvascular network (%, percentage change of the number in comparison to the initial conditions);
  • % percentage portion of aggregated erythrocytes of the total cell number in the observed stream bed; as erythrocyte aggregation, a prolonged adhering of at least 2 to 3 erythrocytes is observed, in which the different types of aggregation are not differentiated);
  • BZ/A number of adhering blood cells on the inner wall of the venules
  • the measurable variables are, if not otherwise indicated, in microvessels with a diameter of about 45 ⁇ m at a specific site at every second in the observation interval of about 15 minutes: determination of the amplitude-frequency spectrum of the vasomotion oscillation).
  • the measurable variables are determined in microvessels with diameters ⁇ 40 ⁇ m.
  • the measurements of the microcirculatory features are made on the mesentery of the small intestine and on the mucous membrane of the small intestine itself in complete, in each case identical segments.
  • the intestine is surgically exposed on the anesthetized and thermostated animal and evacuated in a bath solution thermostated at body temperature (equivalent to the intraperitoneal liquid).
  • the presentation of the microvascular network takes place with the help of an intravital microscopic examination unit in a combined incident light-transmitted light process on the intact organ with computer-assisted image manipulation and processing.
  • the vital microscopic assessments are made with constant macrocirculatory boundary conditions.
  • an orienting survey of the complete microvascular network of the entire mesenteric or intestinal segment is obtained--including its further inflows and outflows, branching geometry and hierarchy and functional vessel identification.
  • the anatomical vessel identification in the stained histological preparation takes place after the end of the test within the scope of the final histological study of all test animals.
  • the recording of the data takes place usually at an interval of 5 minutes before the administration of contrast medium to 10 minutes after the administration of contrast medium every minute.
  • the number of blood cell-perfused branch points increases more quickly by administration of iloprost.
  • the portion of aggregated erythrocytes of the total blood cell number in the network decreases more quickly after administration of iloprost.
  • the number of blood cells adhering to the inner wall of the venules decreases by iloprost.
  • the frequency spectrum of the arteriolar vasomotion exhibits smaller deviations from the normal state by iloprost administration than with exclusive administration of contrast media.

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US20050282903A1 (en) * 2004-04-12 2005-12-22 United Therapeutics, Inc. Use of Treprostinil to treat neuropathic diabetic foot ulcers
US7750041B2 (en) 2001-03-26 2010-07-06 Bayer Schering Pharma Aktiengesellschaft Preparation for the prophylaxis of restenosis
US8257305B2 (en) 2002-09-20 2012-09-04 Bayer Pharma Aktiengesellschaft Medical device for dispensing medicaments
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AU2150497A (en) * 1996-01-25 1997-08-20 Schering Aktiengesellschaft Improved concentrated injection and infusion solutions for intravenous adminis tration
WO2000076496A1 (fr) * 1999-06-14 2000-12-21 Toray Industries, Inc. Composes facilitant l'accumulation de medicaments dans des tissus tumoraux
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EP0609336A1 (de) 1994-08-10
EP0609336B1 (de) 1998-01-28
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DE59209175D1 (de) 1998-03-05
CA2121838A1 (en) 1993-04-29
DE4135193C1 (zh) 1993-03-11
GR3026324T3 (en) 1998-06-30
ATE162718T1 (de) 1998-02-15
DK0609336T3 (da) 1998-09-21
JPH07500585A (ja) 1995-01-19
WO1993007875A1 (de) 1993-04-29
ES2114570T3 (es) 1998-06-01

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